By Michael Romano
I think sometimes we as humans like to think we have more control over our lives than we really do. We go about our days confidently making decisions as if we are in charge, but many of the situations we encounter are out of our control. Anyone here who has experienced significant health problems knows this all too well. My own experiences with polycystic kidney disease have often left me feeling powerless and wondering if there is much of anything we do have control over.
I thought I was healthy for much of my childhood and young adulthood. I grew up in the picturesque part of rural northern New Jersey, surrounded by mountains and cows...far from the smoggy Turnpike and the trashy but endearing-kind-of-trashy Jersey shore. I spent my childhood playing the saxophone, loving school and never pumping my own gas--that’s against the law in New Jersey. I moved to Boston in 2002--to this very street in fact--to attend Boston University where I studied biology and education. I went to grad school across the river at Harvard, and then started teaching. I’ve been teaching high school biology, marine biology and chemistry at the same suburban high school for the past twelve years, save last year when I took a sabbatical to work at NASA in Washington, DC. I came back from NASA to get a kidney.
I was diagnosed six years ago with polycystic kidney disease (PKD). It’s a genetic condition where as time goes on, cysts grow on the kidneys, limiting their ability to filter your blood and eventually leading to total kidney failure. I actually found out I had PKD as somewhat of a fluke...there was no family history of it, and patients don’t usually show many symptoms until your kidneys fail and it’s too late. One symptom is high blood pressure, which I did have in my early twenties, but my doctor chalked it up to “family history” and put me on an ACE inhibitor to keep it at bay. I went to the emergency room on the eve of my 28th birthday because something wasn’t right--I was having arm pain, chest pain, shortness of breath...I self-diagnosed this as a heart attack by reading WebMD, which is apparently a pretty common thing among millennials based on the number of memes I’ve seen about this. It definitely wasn’t a heart attack, but the symptoms were caused by abnormal blood chemistry that was kidney related. It’s funny thinking back to that day--the doctor wanted to keep me overnight for tests and observations, but I protested because the next day was my birthday and I had reservations at Oleana. Locals will agree--totally disappointing to have to miss that! But she insisted, especially considering that something serious might be wrong with my kidneys. One kidney ultrasound later, the characteristic kidney cysts of PKD were made visible and I was officially diagnosed with PKD. That high blood pressure I’d been treating? A classic symptom of PKD. (Luckily, the diagnosis and discharge came a few hours before dinner, which was delicious by the way.)
The next few years were marked by semi-annual nephrologist visits. They largely went the same each time...a slight decrease in my kidney filtration rate (bad), an ominous warning about the eventual renal failure I would experience and impending need for a transplant, and a rebooking for a follow-up in six months. Then every three months. I actually really liked my nephrologist--he was personable, compassionate, and talked to me like an educated person--he knew that I was reading up on my disease (and in primary literature--not on WebMD). These visits were emotionally-draining too though, because his recommendations and diagnoses sounded overly serious for how personally healthy I still felt. I didn’t *feel* like a sick person, you know? I’m not sure healthy people really have a concept of what it means to be a “sick person” anyway. We spend time with family members in the hospital. We see news stories about communities rallying around children in hospital beds hooked up to IVs, or pictures on Facebook of a woman wearing a bandana to cover her head that has gone bald from chemotherapy--that’s a sick person. That’s not me...I just had high blood pressure, right?
As time went on I did start to feel some physical symptoms though. As my kidneys became less able to filter out my blood, my blood filled with “junk” and this made me really tired. I also had a few flare-ups of gout—a really painful arthritis that can be caused by kidney disease. I was spending my summers teaching in Hong Kong, and the long flights became more arduous as my feet and legs swelled. My last trip to Hong Kong in 2017 was nothing short of a cluster...my feet were so swollen that I couldn’t wear shoes, ended up in a Hong Kong emergency room, and then had to teach on crutches for a few days. I knew a transplant was imminent...I was just hoping I could postpone it...well...indefinitely, you know? I was compartmentalizing my illness, which was easy to do because I still mostly felt fine, and no one could tell me when my kidneys would ultimately fail...it could be a year it could be a decade or more.
Part of this uncertainty came from my GFR, which stands for “glomerular filtration rate.” This is an indicator of how well your kidneys are filtering and working, which can be determined from a blood test. A normal, healthy GFR is 59 or greater. Mine had been hovering in the mid-20s for a few years. I knew that when I dropped below 20 I would qualify to be listed on the National Kidney Registry and real discussions of a kidney transplant could begin. This happened in January of 2017, and then it all finally seemed real. I didn’t realize my wait for a deceased kidney would be many years in Massachusetts. I have type O blood, which is highly desirable for blood and organ donations (if I were the donor), because it is a blood type that is highly compatible in many people, regardless of their blood type. The flip side of that, however, is that type O individuals can *only* receive blood and kidneys from other type O people, making the wait for type O kidneys exceedingly long--five or six years.
I started looking for a living donor, because if my kidneys totally failed before finding a donor, I would have to go on dialysis or I would die. Dialysis is crappy. It takes a huge physical toll on your body. It requires hours of treatment three days a week, severely limiting your ability to travel, or just live an independent life. It’s also not a permanent solution, because if you stop dialysis you will ultimately die. I didn’t want this, not in my early 30s. I started looking for a kidney among family members, but there were no healthy type O matches. This was frustrating because so many of my family members wanted to donate, knowing that you only need one healthy kidney to live a long, healthy life. After a year of looking and waiting and watching my GFR tick down, in January of 2018 I took to social media to ask for a kidney. The results were totally overwhelming. My Facebook post went viral, mostly being shared by friends, colleagues and former students. With all of those shares, I had over 60 type O people submit applications to be my donor! The hospital couldn’t tell me the names of those who submitted applications because of privacy laws, but people told me themselves: friends, colleagues, former students, parents of students, former classmates from when I went to high school, parishioners from my parents’ church...just so many generous and brave people.
I met Genevieve 12 years ago. She and I teach at the same high school, and while our classrooms were on opposite sides of the building when we met (she taught English and I taught biology at the time), over the years we’ve become good friends through co-advising the Student Council, chaperoning dances together, working as building reps for the teachers’ union and serving on committees together. I fondly remember working with Genevieve on a committee charged with re-writing our school’s mission statement several years ago. I had some pretty eloquent suggestions for our new mission statement, and Genevieve called me a “wordsmith.” That’s high praise coming from an English teacher! Ultimately all of my mission statement suggestions were ignored, but to this day, it’s one of the nicest compliments I’ve ever received.
It turns out this friend who called me a “wordsmith” a decade earlier saw my Facebook post, and after months of testing turned out to be a very close kidney match, and was willing--nay, excited--to donate one to me! I remember the conversation Genevieve and I had about the transplant timeline once the process was finalized--it was like we were scheduling a coffee date. “How about summer?” “Actually, I have a trip planned. Maybe early fall?” “Well, we should get the school year rolling at least...maybe October?” “I have a wedding the second week--could we shoot for the third week?” And like that, we scheduled this crucially-important medical procedure for October 25th, almost seven months ago today!
The transplant itself was certainly scary, and I remember the day pretty vividly. I showed up to the perioperative area at 8am, changed into my ugly blue transplant gown, and met a lot of faces I would see over and over throughout the day like the surgeon, the anesthesiology team, and the nurses. I had stopped eating the night before and stopped drinking at 7am, so I was hungry, thirsty, nervous and ornery. To add to my unease, I was hoping to see Genevieve that morning, but our paths didn’t cross. I was really frustrated by this, especially because I knew she was going under the knife first. By 9:30 I was being wheeled through the bowels of the hospital to the operating room. My anesthesiologist was wearing a Red Sox skull cap--a wicked Boston thing to witness. There were SO many scissors in the operating room, but I was reassured they were not all for me. In fact, this was one of the last things I remember--I was unconscious before they even put the oxygen mask on. I didn’t even get to the counting backwards, which to be honest was kind of disappointing. The next thing I know it was 7pm and I was waking up in my recovery room. I didn’t feel much pain at first (drugs) but I also didn’t feel great (also drugs), but I was told the kidney was working great and I was making beautiful urine, and honestly that’s the nicest thing anyone had said to me in a few days, so it was quite the compliment. Genevieve was recovering on the same floor, and I finally got to see her the next day. I remember feeling incredibly grateful walking over to see her. It was also incredibly hard to walk--huge incision, catheter in, hooked up to IVs, lots of pain--but I felt relieved it was over, and incredibly close to someone who had always been a good friend.
Genevieve’s recovery was so fast. It was such a positive light when I would go for a walk around the transplant floor and see her smiling face. Mine was a little bumpy. The kidney they removed from me was very large and inflamed. They had to take a lot more tissue out than expected, and as a result I developed an ileus, which essentially means my digestive system shut down. I started vomiting so they inserted a tube through my nose into my stomach that sucked out over a liter of grossness over a couple days. I don’t think I’d felt this physically miserable before. It hurt to sleep, to move and I couldn’t eat. I also ended up being allergic to one of my medicines, so I had some hives. Ironically, I also had one last painful post-transplant gout attack.
The victories were pretty sweet though. You forget what an accomplishment something like a catheter removal is! I was discharged a week after the transplant on Halloween. In remember getting a small cup of M&Ms with my lunch that day, and watching the Red Sox victory parade on TV while waiting to be discharged. I was relieved to finally be home and have my parents there to help me, though recovery would continue to be slow and difficult. Other small victories like taking a shower, going to the bathroom without pain, walking without pain, sleeping through the night, lifting groceries, being out in public, returning to work, and feeling like a normal, healthy person again really made me reflect on the entire process. The regimen of anti-rejection drugs is much more manageable than I imagined they would be, and the bloodwork and follow-up visits have significantly reduced in frequency. My immune system is compromised, of course, but even that has noticeably regained strength from right after the transplant. So I do notice a positive physical improvement, and my attitude has improved as well. I feel like I have a new lease on life--a chance to live a long, healthy, productive life that wouldn’t have been possible without Genevieve’s kidney. I feel like I have a responsibility to help other patients use resources like social media to find a donor. I recently spoke on a panel to a group of pre-transplant recipients, and continue to volunteer for National Kidney Foundation walks. Did you know that my transplant and associated costs were in excess of $300,000? Fortunately I have good health care, and paid less than $2,000. Unfortunately, many Americans don’t have this luxury. It shouldn’t be a luxury, though, it should be a right.
Genevieve and I have been using our platform as teachers to spread awareness about living organ donation as well. People have asked if it’s weird seeing my kidney donor now. Some friends had encouraged me to find a donor that I don’t know. What happens of something goes wrong? Will I forever feel indebted to her? In fact, it’s one of the greatest blessings to see her walking down the hall at school. Colleagues have shared how special it is to see us together, and how it gives them hope. We even have our photograph in the yearbook together, as our story has inspired students too. It’s a pretty special feeling knowing that she so selflessly saved my life, and I get to share this bond with her that most people will not ever get to experience. I do feel a greater sense of responsibility now--I have to do something good with this opportunity she gave me. I think that’s why opportunities like this to share our story are so important. I can share our story, so I must.
It’s hard to thank someone who donates an organ to you. It’s hard to find the right words to say, even for a wordsmith. My gratitude is there in many forms, however: the occasional text asking her to coffee, the soft smile on my face when I find her in the break room between classes, the messages of reassurance I share with other pre-transplant recipients, and the interactions with my family and friends that I can now spend many more healthy years with. I never would have known a decade ago at those Student Council dances or teacher meetings what future bond we would ultimately share, but that’s the essence of the human experience. We can’t control many aspects of our own health, or predict what the future holds. We can, however, cultivate friendships with those random people we meet at work. We can express gratitude to those who help us along when we’re struggling physically and emotionally. We can share our hardships and experiences with others, especially those going through similar health challenges to make them feel less anxious. We can also never really know what hardships our friends and colleagues might be facing in their personal lives, so we can practice patience and empathy in our interactions with others. We can be grateful for the things we can control and the challenges we don’t have to face. And most importantly we can share our stories--in doing so we are able to reshape our perspectives on life and the importance of the relationships we forge in it.
